Document Detail


Systemic mastocytosis in adults: 2011 update on diagnosis, risk stratification, and management.
MedLine Citation:
PMID:  21442641     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
DISEASE OVERVIEW: Systemic mastocytosis (SM) results from a clonal proliferation of abnormal mast cells (MC) in one or more extracutaneous organs.
DIAGNOSIS: The major criterion is presence of multifocal clusters of morphologically abnormal MC in the bone marrow. Minor diagnostic criteria include elevated serum tryptase level, abnormal MC expression of CD25 and/or CD2, and presence of KITD816V.
RISK STRATIFICATION: The prognostic relevance of the 2008 World Health Organization (WHO) classification of SM has recently been confirmed. Classification of SM patients into indolent (SM), aggressive SM (ASM), SM associated with a clonal non-MC lineage disease (SM-AHNMD), and mast cell leukemia (MCL) subgroups is a useful first step in establishing prognosis.
RISK-ADAPTED THERAPY: SM treatment is generally palliative. ISM patients have a normal life expectancy and receive symptom-directed therapy; infrequently, cytoreductive therapy may be indicated for refractory symptoms. ASM patients have disease-related organ dysfunction; interferon-α (±corticosteroids) can control dermatological, hematological, gastrointestinal, skeletal, and mediator-release symptoms, but is hampered by poor tolerability. Similarly, cladribine has broad therapeutic activity, with particular utility when rapid MC debulking is indicated; the main toxicity is myelosuppression. Imatinib has a therapeutic role in the presence of an imatinib-sensitive KIT mutation or in KITD816-unmutated patients. Treatment of SM-AHNMD is governed primarily by the non-MC neoplasm; hydroxyurea has modest utility in this setting. Dasatinib's in vitro anti- KITD816V activity has not translated into significant therapeutic activity in most SM patients. In contrast, preliminary data suggest that Midostaurin may produce significant decreases in MC burden in some patients.
Authors:
Animesh Pardanani
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American journal of hematology     Volume:  86     ISSN:  1096-8652     ISO Abbreviation:  Am. J. Hematol.     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-03-28     Completed Date:  2011-05-20     Revised Date:  2014-08-08    
Medline Journal Info:
Nlm Unique ID:  7610369     Medline TA:  Am J Hematol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  362-71     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Wiley-Liss, Inc.
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MeSH Terms
Descriptor/Qualifier:
Adult
Antineoplastic Agents / administration & dosage,  therapeutic use*
Benzamides
Bone Marrow / pathology
Cladribine / administration & dosage,  therapeutic use
Disease-Free Survival
Humans
Hydroxyurea / administration & dosage,  therapeutic use
Interferon Type I / administration & dosage,  therapeutic use
Mast Cells / drug effects,  metabolism,  pathology
Mastocytosis, Systemic* / diagnosis,  drug therapy,  etiology
Piperazines / administration & dosage,  therapeutic use
Point Mutation
Proto-Oncogene Proteins c-kit / genetics
Pyrimidines / administration & dosage,  therapeutic use
Recombinant Proteins
Risk
Staurosporine / administration & dosage,  analogs & derivatives,  therapeutic use
Thiazoles / administration & dosage,  therapeutic use
Chemical
Reg. No./Substance:
0/Antineoplastic Agents; 0/Benzamides; 0/Interferon Type I; 0/Piperazines; 0/Pyrimidines; 0/Recombinant Proteins; 0/Thiazoles; 120685-11-2/4'-N-benzoylstaurosporine; 47M74X9YT5/Cladribine; BKJ8M8G5HI/imatinib; EC 2.7.10.1/Proto-Oncogene Proteins c-kit; H88EPA0A3N/Staurosporine; RBZ1571X5H/dasatinib; X6Q56QN5QC/Hydroxyurea

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